Thiotepa: What to Expect, Side Effects, and More

Thiotepa is a chemotherapy medicine. If you have been diagnosed with early- or advanced-stage breast cancer, you may be given thiotepa alone or in combination with other chemotherapy medicines. 

See thiotepa prescribing information.

Thiotepa is a type of chemotherapy called an alkylating agent. It works by damaging the DNA inside breast cancer cells so they can’t divide.

Cytoxan is another alkylating agent.

The recommended dose of thiotepa is 0.3 to 0.4 mg/kg intravenously. Infusions are given at one- to four-week intervals. 

Like all cancer medicines, thiotepa can cause side effects, some of them serious.

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  low white blood cell count

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  nausea

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  vomiting

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  loss of appetite

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  fatigue

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  hair changes

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  irregular periods — this can include temporary cessation (usually resume after medication is completed) or permanent cessation of menstrual periods depending on your age and other factors

Thiotepa may also cause itching, blistering, peeling, or discoloration of the skin. To reduce this risk, you should shower or bathe at least twice daily for 48 hours after administration of thiotepa. If your skin is affected, you should change the occlusive dressing and clean the covered skin at least twice daily and change bed sheets every day during treatment.

More serious side effects can occur, including:

Myelosuppression: This is a condition in which bone marrow doesn’t make enough blood cells or platelets. Your doctor will use blood tests such as Complete Blood Counts (CBC) to monitor for myelosuppression during thiotepa treatment. Your thiotepa dosage will be adjusted weekly based on your pretreatment control blood counts. 

Infection: Thiotepa may increase your risk of certain infections, including sinusitis, urinary tract infection, and respiratory tract infection. 

Hypersensitivity: Hypersensitivity reactions, including anaphylaxis, can occur with thiotepa. If anaphylactic or other severe allergic reaction occurs, tell your doctor. 

Cutaneous Toxicity: Occasionally, thiotepa may be excreted through the skin. Signs this is occurring include skin discoloration, blistering, and peeling that may be more severe in the groin, armpit, skin folds, in the neck area, and under dressings. 

Hepatic Veno-Occlusive Disease: Hepatic veno-occlusive disease occurs when some of the veins in the liver are blocked, which causes a decrease in blood flow inside the liver.  Symptoms of hepatic veno-occlusive disease include weight gain, yellowing of the skin and whites of the eyes, dark-colored urine, and abdominal pain.

Central Nervous System Toxicity: Brain changes have occurred in some people treated with high doses of thiotepa. If you experience headaches, disorientation, confusion, amnesia, hallucinations, drowsiness, seizures, or forgetfulness, tell your doctor right away.

Carcinogenicity: There is an increased risk of secondary cancer with thiotepa treatment.

Women who are pregnant, planning to get pregnant, or breastfeeding should not take thiotepa.

The cost of thiotepa may vary. The price you’ll pay depends on the drug manufacturer, your health insurance provider and plan, where you live, and the pharmacy you use. You may also be charged for the office visits required for thiotepa infusions.

Note: Your insurance company may require you to get prior authorization before covering thiotepa. 

Learn more about financial assistance and medicine cost-lowering tips.